Pio Luca, Guérin Florent, Martucci Cristina, Martelli Helene, Gauthier Frédéric, Branchereau Sophie
Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Paediatric Surgery Department, Hôpital Bicêtre APHP, Paris Saclay University, 91190 Paris, France.
Children (Basel). 2023 Jan 2;10(1):89. doi: 10.3390/children10010089.
Aim of the study: The cavitron ultrasonic surgical aspirator (CUSA) has gained popularity in adult surgical oncology, but its application in children is limited to liver surgery and neurosurgical procedures. The complete resection of neuroblastoma with image-defined risk factors (IDRFs) is still considered one of the most difficult procedures to achieve in pediatric surgical oncology, with a high morbidity rate and potential risk of intraoperative mortality. The aim of our study is to describe the application of ultrasonic dissection in neuroblastoma with IDRFs. Methods: A retrospective study was performed, analyzing patients operated on from 2000 to 2018. Patient characteristics, resection completeness, and postoperative surgical and oncology outcomes were analyzed. Main results: Twenty-six patients with high-risk neuroblastoma and IDRFs were operated on in the study period with a CUSA. A complete macroscopic resection was performed in 50% of patients, while the other half was operated on with minimal residual (<5 mL). Six post-operative complications occurred without the need for surgery (Clavien−Dindo < 3). The overall survival was 50%, with a median follow-up of 69.6 months (5.6−140.4). Conclusions: The application of the CUSA in neuroblastoma with IDRFs can be considered an effective and safe alternative technique to achieve a radical resection.
超声外科吸引器（CUSA）在成人外科肿瘤学中已得到广泛应用，但其在儿童中的应用仅限于肝脏手术和神经外科手术。对于伴有影像界定危险因素（IDRFs）的神经母细胞瘤进行完整切除，仍是小儿外科肿瘤学中最难实现的手术之一，其发病率高且存在术中死亡的潜在风险。我们研究的目的是描述超声解剖在伴有IDRFs的神经母细胞瘤中的应用。方法：进行一项回顾性研究，分析2000年至2018年接受手术的患者。分析患者特征、切除完整性以及术后手术和肿瘤学结局。主要结果：在研究期间，26例伴有高危神经母细胞瘤和IDRFs的患者接受了CUSA手术。50%的患者实现了肉眼完整切除，而另一半患者手术残留最小（<5 mL）。发生了6例无需再次手术的术后并发症（Clavien-Dindo<3级）。总生存率为50%，中位随访时间为69.6个月（5.6 - 140.4个月）。结论：CUSA在伴有IDRFs的神经母细胞瘤中的应用可被视为实现根治性切除的一种有效且安全的替代技术。
